Impact of an Embedded Palliative Care and Hospice Practitioner in the Medical ICU
Trial Snapshot
- Phase
- Not Applicable
- Status
- Recruiting
- Enrollment
- 2,600
- Locations
- 1
- Primary Endpoint
- ICU Length of Stay
Study Overview
Brief Summary
The goal of this study is to investigate whether embedding a hospice and palliative care practitioner within a medical intensive care unit will improve patient outcomes and healthcare usage. The practitioner will work solely within the medical intensive care units and offer timely as well as proactive consultations based on clinical criteria and estimated mortality risk. The study team will compare patients seen by the practitioner to patients in an adjacent ICU and historical patients to determine whether patient care is improved by this intervention.
Detailed Description
The study goal is to determine whether an embedded palliative care practitioner in the medical ICU improves patient outcomes, palliative care/hospice utilization, and healthcare quality metrics. The medical ICUs included in this study are comprised of two geographically co-located units that provide care for medically complex patients from a large tertiary referral area. Palliative care services are currently available as a consultative service at the ICU clinicians' discretion for patients with palliative needs such as complex goals of care, advanced symptom management, or chronic critical illness. Under the current consultation model, palliative care consultation is requested in a minority of critically ill patients and consults occur on average 5-14 days after a patient's admission. Hospice services are similarly available on a consultative basis for patients that the primary team has determined are suitable for hospice, however, logistical limitations of hospice consultation may lead to delays in inpatient hospice transfers and home hospice discharges.
This study's intervention is to embed a palliative care/hospice practitioner within the medical ICUs as a dedicated palliative care and hospice consultant who will offer proactively triggered palliative care consultations early in a patient's ICU stay as well as immediate availability for standard-of-care palliative care and hospice consultations.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Sequential
- Primary Purpose
- Supportive Care
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Patients admitted to the medical intensive care units at a tertiary referral center
- •Patients must be at least 18 years of age
Exclusion Criteria
- Not provided
Arms & Interventions
Prospective Hospice and Palliative Care Intervention
This arm comprises patients admitted to the specific medical intensive care unit in which the hospice and palliative care practitioner is currently active. This will include all patients admitted to a single medical intensive care unit during the anticipated first half of the intervention timeframe, followed by all patients admitted to both medical intensive care units during the second half of the intervention timeframe.
Intervention: Embedded Hospice and Palliative Care Practitioner (Other)
Prospective Standard of Care
This arm comprises patients admitted to the medical intensive care unit in which the hospice and palliative care practitioner is not currently active, but which may experience a group effect due to the study's ongoing enrollment and the practitioner's presence. This will include all patients admitted to a single medical intensive care unit during the anticipated first half of the intervention timeframe, prior to the practitioner becoming active in both intensive care units.
Intervention: Embedded Hospice and Palliative Care Practitioner (Group Effect) (Other)
Historical Controls
This arm comprises historical patients admitted to the medical intensive care units in the year prior to study enrollment.
Intervention: None (Historical) (Other)
Outcomes
Primary Outcomes
ICU Length of Stay
Time Frame: From date of enrollment until hospital discharge, assessed up to 1 year
Length of stay in any intensive care unit during the hospitalization
Code Status De-escalation
Time Frame: From date of enrollment until hospital discharge, assessed up to 1 year
Frequency of changes in code status to limited code or comfort measures only
Secondary Outcomes
- Presence of Advance Care Planning Documentation during Current Admission(From date of enrollment until hospital discharge, assessed up to 1 year)
- Hospice Enrollment(From date of enrollment until hospital discharge, assessed up to 1 year)
- Time to change in code status, advance care planning documentation, palliative care consultation, and hospice consultation(From date of enrollment until hospital discharge, assessed up to 1 year)
- Location of discharge disposition(From date of enrollment until hospital discharge, assessed up to 1 year)
- Length of Stay Index (Vizient)(From date of enrollment until hospital discharge, assessed up to 1 year)
- Vasopressor Utilization(From date of enrollment until hospital discharge, assessed up to 1 year)
- 30-Day Mortality(Assessed 30 days after hospital admission)
- 30-day Emergency Room Visit(Assessed 30 days after hospital discharge)
- Inpatient Hospice Duration(From date of enrollment until hospital or hospice discharge, assessed up to 1 year)
- Operating cost in dollars, including departmental breakdown(Assessed six months following discharge)
- Hospice Consultation(From date of enrollment until hospital discharge, assessed up to 1 year)
- Palliative Care Consultation(From date of enrollment until hospital discharge, assessed up to 1 year)
- Hospital Length of Stay(From date of enrollment until hospital discharge, assessed up to 1 year)
- Mortality Index (Vizient)(From date of enrollment until hospital discharge, assessed up to 1 year)
- Hospital Mortality(From date of enrollment until hospital discharge, assessed up to 1 year)
- Mechanical Ventilation Duration(From date of enrollment until hospital discharge, assessed up to 1 year)
- 30-day Readmission(Assessed 30 days after hospital discharge)
Investigators
Stephen Wen-Yan Chi
Assistant Professor
Washington University School of Medicine